Randomised controlled trial of follow up care in general practice of patients with myocardial infarction and angina: final results of the Southamptonheart integrated care project (SHIP)

Objective To assess the effectiveness of a programme to coordinate and supp ort follow up care in general practice after a hospital diagnosis of myocar dial infarction or angina. Design Randomised controlled trial; stratified random allocation of practic es to intervention and control groups. Setting All 67 practices in Southampton and south west Hampshire, England. Subjects 597 adult patients (422 with myocardial infarction and 175 with a new diagnosis of angina) who were recruited during hospital admission or at tendance at a chest pain clinic between April 1995 and September 1996. Intervention Programme to coordinate preventive care led by specialist liai son nurses which sought to improve communication between hospital and gener al practice and to encourage general practice nurses to provide structured follow up. Main outcome measures Serum total cholesterol concentration, blood pressure , distance walked in 6 minutes, confirmed smoking cessation, and body mass index measured at 1 year follow up. Results Of 559 surviving patients at 1 year, 502 (90%) were followed up. Th ere was no significant difference between the intervention and control grou ps in smoking (cotinine validated quit rate 19% v 20%), lipid concentration s (serum total cholesterol 5.80 v 5.93 mmol/l), blood pressure (diastolic p ressure 84 v 85 mm Hg), or fitness (distance walked in 6 minutes 443 v 433 m). Body mass index was slightly lower in the intervention group (27.4 v 28 .2; P = 0.08). Conclusions Although the programme was effective in promoting follow up in general practice, it did not improve health outcome. Simply coordinating an d supporting existing NHS care is insufficient. Ischaemic heart disease is a chronic condition which requires the same syst ematic approach to secondary prevention applied in other chronic conditions such as diabetes mellitus.